Percutaneous cervical cordotomy for cancer-related pain

The anatomic rationale of cordotomy involves interruption of pain fibres in the spinothalamic tract. Cordotomy is indicated in cancer patients with limited life expectancy who have severe, unilateral pain. The goal in patients with limited life expectancy should be to improve the quality of survival, which includes improving the patient's ability to interact with others, and to reduce the amount of time spent in contact with healthcare providers. Analgesic optimization alone may fail to adequately control cancer related pain. When successful, percutaneous cervical cordotomy allows significant reduction in pain medications, and reduces the need for clinic visits. Percutaneous procedures are preferred over open procedures for their lower morbidity. The percutaneous cervical cordotomy procedure is technically not simple and requires considerable skills of the physician performing the procedure.     

The cause of failure in high cervical percutaneous cordotomy: An analysis

Summary Factors that might have contributed to failure of high cervical percutaneous cordotomy in 23 patients with intractable pain were investigated. Cordotomy failed in 3 patients, 20 had initially good pain relief (87%). True recurrence occurred in 5 patients, 3 of them developed pain elsewhere.Analysis of these three types of failure showed a purely technical cause in 2 cases; other failures or recurrences were due to the underlying disease being not strictly unilateral, or possibly to the existence of other ascending pathways carrying nociceptive impulses apart from the spinothalamic tract.There was no influence of age, sex, type of cancer or previous medication on the result of percutaneous cordotomy. Patients with plexus involvement did better than those with bone metastasis.     

CT-guided percutaneous selective cordotomy for treatment of intractable pain in patients with malignant pleural mesothelioma

Summary.  Malignant mesotheliomas are neoplasms that arise from mesothelial cells and cause intractable pain in the chest wall, usually located unilaterally. This local pain can be well controlled by computerized tomography (CT)-guided percutaneous cordotomy (PC). One hundred and fifty-three patients suffering from intractable pain due to malignancy were treated with CT-guided cordotomy between 1988 and 2001. Seventy of the 153 patients had pulmonary malignancy. Among these, 40 had bronchogenic carcinoma, 11 had Pancoast tumors and the remaining 19 had mesothelioma. The latter 19 cases with malignant mesothelioma suffering from unilateral pain were treated with CT-guided PC. In 18 cases, pain was controlled totally and, in one, partial pain control was obtained. Selective pain control was obtained in 15 cases, in whom narcotic drugs were discontinued postoperatively. Post-cordotomy dysesthesia was noted in only one case, and no complication or mortality was observed. In the treatment of intractable pain, CT-guided cordotomy is a perfect method in selected cases with malignancy. This is the most effective and suitable treatment modality for local pain due to malignant mesothelioma. Published online June 20, 2002     

The role of percutaneous cordotomy in the treatment of chronic cancer pain

Summary The authors report on 53 cervical percutaneous cordotomies in 52 patients suffering from chronic unilateral cancer pain.The evaluation of the results is based upon the patient's report of complete pain relief. Immediate and long term pain relief as well as complications and mortality rate are analysed. Excellent surgical results were obtained in 73% after one week and in 63% 15 weeks after operation. The topographical distribution of pain seems to influence the pain relief; the location of the cancer does influence the nature of the complications.Furthermore, the occurrence of other pain syndromes, controlateral to or above the level of analgesia, is evaluated. This appears to be an important limitation of the usefulness of cordotomy.     

A neural model for chronic pain and pain relief by extracorporeal shock wave treatment

The paper develops a new theory of chronic pain and pain relief by extracorporeal shock wave treatment. Chronic pain without underlying anatomical disorder is looked at as a pathological control function of memory. Conditioned reflexes are considered to be engraved memory traces linking sensory input of afferent signals with motor response of efferent signals. This feature can be described by associative memory functions of the nervous system. Some conditioned reflexes may cause inappropriate or pathological reactions. Consequently, a circulus vitiosus of pain sensation and muscle and/or vessel contraction is generated when pain becomes chronic (pain spiral). The key feature is a dedicated engram responsible for a pathological (painful) reaction. The pain memory may be explained by the concept of a holographic memory model published by several authors. According to this model it is shown how nervous systems may generate and recall memory contents. The paper shows how extracorporeal shock wave treatment may reorganize pathologic memory traces, thus giving cause to real and permanent pain relief. In a generalized manner, the idea of associative memory functions may help in the understanding of conditioning as a learning process and explain extracorporeal shock wave application as an efficient treatment concept for chronic pain. This concept may open the door for new treatment approaches to chronic pain and several other disorders of the nervous system.     

产后慢性泌尿生殖疼痛的危险因素分析

目的 探讨产后慢性泌尿生殖疼痛(chronic urogenital pain,CUP)相关性盆底肌损伤的主要危险因素.方法 选取2018年5月至2020年4月产后42 d至6个月于我院盆底康复中心行产后随访并诊断为CUP的患者120例为研究对象(CUP组),以同期来我院行产后随访无盆底功能障碍性疾病的妇女100例为对...     

The neurobiology of chronic pain states

Plasticity enables alterations in transmission in nociceptive systems. It is this plasticity in the nervous system that can alter the linear relation between noxious stimuli and the perception of pain and is important in the switch from acute to chronic pain. In this way, a number of CNS mechanisms can alter neuronal activity, leading to abnormal ongoing and stimulus-evoked pains due to peripheral and central changes. Peripheral nerves can become sensitized, spinal cord neurons can be rendered hyperexcitable and ascending projections to higher centres can further trigger changes in descending controls from the midbrain and brainstem. Together, these changes, all of which appear to involve reversible physiological and pharmacological plasticity, can alter the relationship between an applied stimulus and the perceived response and so lead to persistent pain states.     

长期接受慢性疼痛治疗患者的围术期疼痛管理进展

背景 慢性疼痛患者往往长期接受一系列的治疗措施来控制疼痛,如因某种疾病要接受手术治疗时,这类患者的围术期疼痛管理是非常棘手的. 目的 了解不同慢性疼痛治疗措施下患者的围术期疼痛管理进展. 内容 分别阐述口服阿片药物、抗抑郁药、抗惊厥药,应用脊髓刺激器及鞘内药物输注系统等慢性疼痛治疗措施下患者的围术期疼痛管理策略.趋向 对长期接受慢性疼痛治疗患者的围术期疼痛管理的研究,将有助于提高这类患者在围术期的舒适度及安全度,加快术后康复.     

Epidural morphine for postoperative pain relief in children

Epidural morphine for postoperative pain relief is in general use, and has proved to be very efficient in adults. The epidural technique and the use of epidural morphine are much less frequent in children. For 2 years we have prospectively followed 76 children who had epidural morphine for postoperative pain relief after major abdominal surgery. The age distribution was from newborn to 13 years, with a median age of 12 months. It was estimated that 94% of the patients had good analgesia for the first 24 postoperative hours and no other opioids were given. The side effects were few, but one case of respiratory depression was seen and 20% of the children had pruritus. There were four dural punctures and three catheters slipped out accidentally, but otherwise the treatment was continued as long as it was considered necessary (1–11 days). The use of postoperative ventilatory support decreased during the investigation. We observed a change in the sleeping pattern with an increased number of sleep–induced myoclonia during the administration of epidural morphine. In conclusion, the use of epidural morphine in children for postoperative pain relief is very efficient. The minimal effective dose has not been established as yet, but 50 Hg/kg every 8 h, supplemented with small doses of bupivacaine, provides excellent analgesia in the immediate postoperative period after major abdominal surgery. The side effects are few, but the risk of respiratory depression is always present and observation in the intensive care unit or recovery for the first 24 h is strongly recommended.     

Paediatric chronic pain

Many children and adolescents experience chronic pain at some point in their childhood. While the majority may be successfully supported by their local services, some may develop persistent pain-related functional disability that should prompt referral to a multidisciplinary paediatric pain service for assessment. These teams work with the family to provide a framework for promoting rehabilitation and restoration of function based on the biopsychosocial model. Mental health difficulties including psychological trauma are often a significant factor. Individualized therapeutic work is core to the pain management pathway. Medications and therapeutic injections are used less frequently in children compared to adult practice but may have a role in facilitating rehabilitation as part of a multidisciplinary approach.     

多瑞吉用于术后镇痛的临床研究

目的　探讨多瑞吉用于术后镇痛的效能和安全性。方法　择期上腹部手术病人 2 7例 ,随机分为两组 ,多瑞吉组 (D组 ) 13例 ,对照组 (C组 ) 14例。术前 45分钟 ,D组两侧锁骨下各贴 1片 2 5 μg/h的贴膜 ,C组予不含药物的贴片。贴膜应用 2 4小时后 ,两组病人均去除贴膜。术中两组均采用气管插管静吸复合麻醉 ,手术结束病人立即送PACU ,拔管、病人清醒诉痛后 ,应用吗啡PCA泵 ,所有病人持续监测SpO2 、RR、ECG、NBP 44小时 ,每隔 4小时记录一次吗啡用量、VAS评分 ,并观察有无恶心、呕吐、瘙痒、尿潴留等副反应。结果　 (1)镇痛效果 :术后各时段D组VAS评分均明显优于C组 ;(2 )吗啡用量 :术后 4小时、8小时D组吗啡用量与C组无统计学差异 ,8小时后D组吗啡用量明显少于C组 ;(3)呼吸影响 :两组病例均未出现SpO2 低于 90 % ,D组呼吸频率术后与术前无明显差异 ;(4)副反应 :恶心、呕吐、瘙痒、尿潴留发生率两组相似。结论　 5 0 μg/h多瑞吉用于成人 1小时左右上腹部手术是安全有效的 ,并且不明显增加副反应发生     

Paediatric chronic pain

Chronic pain in childhood is common and if untreated may lead to significant pain-related disability, emotional disturbance and poor school attendance. Many children and adolescents are successfully managed outside of specialist paediatric pain management clinics in a wide range of clinical settings. However, some children require the expertise of a multidisciplinary pain management team in a dedicated paediatric centre. Following multidisciplinary assessment an individualized pain management plan is agreed with the family. Treatment options can be classified into pharmacological, physical and psychological therapies. The aim of treatment is to facilitate a restoration of function for the child, working with the family as a whole.     

Surgical management of chronic pain

Chronic pain is believed to affect around 14 million people in England. It impacts on society and places a high demand on healthcare with an estimated cost to the UK National Health Service £10 billion per annum. Management of chronic pain is therefore a major clinical challenge. Many patients will be managed effectively in community or primary care while a proportion will require specialist secondary and tertiary care pain services. For these a multidisciplinary approach with pharmacological and non-pharmacological strategies will improve quality of life but there will still be a proportion with significant symptoms that cannot be helped in this fashion. Selected patients with intractable pain may benefit from targeted surgical procedures, reducing the long-term physical, emotional and financial burden that results from their situation. The technical and clinical challenge is determining ‘who’, ‘what’, ‘where’ and ‘when’ in order to provide the best possible long-term outcome and quality of life. Over the past three decades, with the exception of procedures for trigeminal neuralgia, the bias in neurosurgical intervention for chronic pain relief has changed from ablative lesioning towards reversible, low-risk neuromodulation techniques wherein electrical stimulation of part of the nervous system or intrathecal medication is used to control pain or modify physiology.